Journal of Pediatric Orthopaedics - 2026-01-01 - Journal Article; Systematic Review; Comparative Study
Plate Versus Screw Fixation in Treating Pediatric Femoral Neck Fractures: A Systematic Review.
Chen YP, Lin CH, Hong CK, Yao SH, Chen CH
Topics
Key Takeaway
In 950 pediatric femoral neck fractures across 31 studies, plate fixation reduced AVN and premature physeal closure compared to screw fixation, with the greatest benefit in Delbet III/IV and displaced fractures.
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Summary
This systematic review compared plate versus screw fixation for pediatric femoral neck fractures across PubMed, EMBASE, Cochrane, and Google Scholar. Plate fixation demonstrated lower rates of AVN and premature physeal closure versus screw fixation; subgroup analysis of Delbet III/IV and displaced fractures showed plate fixation also reduced leg length discrepancy in these higher-risk groups. Functional outcomes by Ratliff criteria were equivalent between groups, and nonunion rates were similar, though coxa vara was slightly more frequent with plate fixation.
Key Limitation
The review is limited to Level III–IV source studies without quantitative meta-analysis, meaning reported differences in AVN and physeal closure rates are not accompanied by pooled odds ratios or confidence intervals, limiting the strength of the comparative conclusions.
Original Abstract
BACKGROUND
Few studies have directly compared plate fixation and screw fixation in treating pediatric femoral neck fractures. The present systematic review compared the postoperative outcomes associated with these 2 fixation methods.
METHODS
The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for articles reporting the outcomes of using plate fixation and screw fixation to treat femoral neck fractures in pediatric populations. Surgical outcomes were evaluated in terms of functional assessments and postoperative complications.
RESULTS
This review included 31 studies involving 950 pediatric femoral neck fracture cases. The Ratliff criteria for functional assessments were comparable between the plate fixation and screw fixation groups. Plate fixation showed a reduced incidence of postoperative avascular necrosis and premature physeal closure compared with screw fixation. In addition, the incidence of coxa vara was slightly higher in the plate fixation group, although the nonunion and leg length discrepancy rates were similar between the screw fixation and plate fixation groups. Moreover, the results of subgroup analyses indicated that plate fixation reduced the risk of avascular necrosis and leg length discrepancy in patients with Delbet III/IV fractures and displaced fractures than screw fixation was.
CONCLUSION
Plate fixation may be a superior option because it showed a reduced risk of postoperative avascular necrosis and premature physeal closure, particularly in patients with Delbet type III/IV or displaced fractures.
LEVEL OF EVIDENCE
Level III-systematic review of retrospective comparative studies and case series.